Neurologic Sequelae after spinal anesthesia are extrenely rare, due in part to use of prepackaged and sterile kits and the small doses of local anesthectics employed. We have experienced 42 years old healthy male developed cental nervous system toxicity due to injection of wrong substance into subarachnoid space. And the patient recovered 3 days later with mild pulmonary edema and about 72 hour anterograde amnesia after symptomatic treatment.
Adult ; Amnesia, Anterograde ; Anesthesia, Spinal ; Central Nervous System* ; Humans ; Male ; Nervous System ; Pulmonary Edema ; Subarachnoid Space* ; Tranexamic Acid*

No abstract available.
Adult* ; Humans ; Magnetic Resonance Imaging*

Steroid sulfatase (STS) is responsible for the hydrolysis of aryl and alkyl steroid sulfates and has a pivotal role in regulating the formation of biologically active estrogens. STS may be considered a new promising drug target for treating estrogen-mediated carcinogenesis. However, the molecular mechanism of STS expression is not well-known. To investigate whether tumor necrosis factor (TNF)-alpha is able to regulate gene transcription of STS, we studied the effect of TNF-alpha on STS expression in PC-3 human prostate cancer cells. RT-PCR and Western blot analysis showed that TNF-alpha significantly induced the expression of STS mRNA and protein in a concentration- and time-dependent manner. Treatment with TNF-alpha resulted in a strong increase in the phosphorylation of Akt on Ser-473 and when cells were treated with phosphatidylinositol (PI) 3-kinase inhibitors such as LY294002 or wortmannin, or Akt inhibitor (Akt inhibitor IV), induction of STS mRNA expression by TNF-alpha was significantly prevented. Moreover, activation of Akt1 by expressing the constitutively active form of Akt1 increased STS expression whereas dominant-negative Akt suppressed TNF-alpha-mediated STS induction. We also found that TNF-alpha is able to increase STS mRNA expression in other human cancer cells such as LNCaP, MDA-MB-231, and MCF-7 as well as PC-3 cells. Taken together, our results strongly suggest that PI 3-kinase/Akt activation mediates induction of human STS gene expression by TNF-alpha in human cancer cells.
Blotting, Western ; Fluorescent Antibody Technique ; Humans ; Male ; Phosphatidylinositol 3-Kinase/genetics/*metabolism ; Phosphorylation/drug effects ; Prostatic Neoplasms/genetics/*metabolism ; Proto-Oncogene Proteins c-akt/genetics/*metabolism ; RNA, Messenger/genetics ; Real-Time Polymerase Chain Reaction ; Recombinant Proteins/genetics/isolation & purification/metabolism ; Signal Transduction ; Steryl-Sulfatase/genetics/*metabolism ; Tumor Cells, Cultured ; Tumor Necrosis Factor-alpha/*pharmacology

PURPOSE: This study aimed to determine the prognostic value of new quantitative parameters of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT), including metabolic tumor volume (MTV), in patients with locally advanced and metastatic gallbladder cancer (GBC). MATERIALS AND METHODS: In total, 83 patients initially diagnosed with locally advanced and metastatic GBC and who underwent 18F-FDG PET/CT at the time of initial diagnosis were retrospectively reviewed. The metabolic volume-based PET parameters of primary tumors and metastatic lesions were measured, including maximum and average standardized uptake values (SUV), MTV, and total lesion glycolysis. An overall survival (OS) analysis was performed using the Kaplan-Meier method with PET and clinical parameters. A Cox proportional hazards regression analysis was performed to determine independent prognostic factors. RESULTS: In univariate analysis, pathologic differentiation (p<0.001), performance status (PS; p=0.003), C-reactive protein (CRP) level (p=0.009), and PET-related SUVmt max (the highest SUV among the metastatic lesions) (p=0.040) and MTVtotal (the sum of the MTVs of both the primary and metastatic lesions) (p=0.031), were significant for OS. In multivariate analysis, MTVtotal (hazard ratio: 2.07; 95% confidence interval: 1.23–3.48; p=0.006) remained significant for the prediction of OS, as did differentiation (p=0.001), PS (p=0.001), and CRP (p=0.039). CONCLUSION: In locally advanced and metastatic GBC, volume-based PET/CT parameters of the total tumor burden of malignancy, such as MTVtotal, were found to be useful for the identification of patients with poor prognosis.
C-Reactive Protein ; Diagnosis ; Electrons ; Fluorodeoxyglucose F18 ; Gallbladder Neoplasms ; Gallbladder ; Glycolysis ; Humans ; Methods ; Multivariate Analysis ; Neoplasm Metastasis ; Positron-Emission Tomography and Computed Tomography ; Prognosis ; Retrospective Studies ; Tumor Burden

This study examined the effects of calcium (Ca) gluconate on collagen-induced DBA mouse rheumatoid arthritis (CIA). A single daily dose of 200, 100 or 50 mg/kg Ca gluconate was administered orally to male DBA/1J mice for 40 days after initial collagen immunization. To ascertain the effects administering the collagen booster, CIA-related features (including body weight, poly-arthritis, knee and paw thickness, and paw weight increase) were measured from histopathological changes in the spleen, left popliteal lymph node, third digit and the knee joint regions. CIA-related bone and cartilage damage improved significantly in the Ca gluconate- administered CIA mice. Additionally, myeloperoxidase (MPO) levels in the paw were reduced in Ca gluconate-treated CIA mice compared to CIA control groups. The level of malondialdehyde (MDA), an indicator of oxidative stress, decreased in a dose-dependent manner in the Ca gluconate group. Finally, the production of IL-6 and TNF-alpha, involved in rheumatoid arthritis pathogenesis, were suppressed by treatment with Ca gluconate. Taken together, these results suggest that Ca gluconate is a promising candidate anti-rheumatoid arthritis agent, exerting anti-inflammatory, anti-oxidative and immunomodulatory effects in CIA mice.
Animals ; Arthritis ; Arthritis, Rheumatoid* ; Body Weight ; Calcium Gluconate* ; Calcium* ; Cartilage ; Collagen ; Humans ; Immunization ; Immunomodulation ; Interleukin-6 ; Knee ; Knee Joint ; Lymph Nodes ; Male ; Malondialdehyde ; Mice* ; Mice, Inbred DBA ; Oxidative Stress ; Peroxidase ; Spleen ; Tumor Necrosis Factor-alpha ; Water*

To examine diseases of the small intestines, the use of different methods including a small bowel series and push type enteroscopy have been employed, but these procedures are restrictive and have a low diagnostic accuracy rate. Recently, the use of double balloon enteroscopy has been introduced, and it is expected that this procedure will be of great value for research of diseases of the small intestine as it enables one to obtain a biopsy tissue sample and to perform diagnostic and therapeutic endoscopy while examining small intestine visually. We report as case of a patient that visited our institution complaining of abdominal pain, and the patient was diagnosed as suffereing from an intestinal obstruction due to a bezoar. The patient was treated by surgery after an investigation with the aid of a double balloon enteroscope.
Abdominal Pain ; Bezoars ; Biopsy ; Double-Balloon Enteroscopy ; Endoscopy ; Humans ; Intestinal Obstruction ; Intestine, Small

Aortic dissection during pregnancy is rare, but is life-threatening event for both the mother and the fetus. Depending on the type of dissection, surgical or medical treatment can be performed. The attempt of cesarean section delivery is determined by gestational age. We experienced a case of aortic dissection at 32 weeks of gestation. The type of dissection was DeBakey type III and was managed medically. Under general anesthesia, cesarean delivery was performed at 35 week's gestation. In pregnant patients complaining of chest or abdominal pain not related to labor, the suspicion of aortic dissection is important for prompt diagnosis and better prognosis.
Abdominal Pain ; Anesthesia, General ; Cesarean Section ; Diagnosis ; Female ; Fetus ; Gestational Age ; Humans ; Mothers ; Pregnancy* ; Prognosis ; Thorax

Multiple primary cancer is defined as the multiple occurrence of malignant neoplasm in the same individual. Synchronous cancers are usually defined as finding the second cancer at the same time or within a 6-month period after the diagnosis of the primary lesion, and metachronous cancers are found at more than 6 months after the initial diagnosis. Multiple primary cancers have been increasing reported on due to prolonged lifespans and the improvement of diagnostic techniques. Nevertheless, triple synchronous cancers have been regarded as a relatively rare finding. We report here on an unusual case of triple synchronous cancer of early gastric cancer, carcinoid tumor of the ampulla of Vater and renal cell carcinoma.
Adenocarcinoma* ; Ampulla of Vater* ; Carcinoid Tumor* ; Carcinoma, Renal Cell* ; Diagnosis ; Neoplasms, Second Primary ; Stomach Neoplasms

BACKGROUND/AIMS: Endoscopic biliary drainage (EBD) has been used effectively as the palliative treatment for malignant biliary obstruction. In high grade strictures, endoscopic stenting can be achieved by dilating devices such as dilating or balloon catheters. Subgroup of malignant biliary obstructions are too stenotic to allow passage of plastic or metal stents. In cases of failure of conventional stenting, we evaluated the efficacy and safety of the 7-Fr Soehendra stent retriever (SSR) used as a dilator. METHODS: From January 1999 to September 2001, 14 patients with malignant pancreaticobiliary stirictures (2 pancreatic, 12 biliary) that could not be traversed with plastic or metal stents, underwent stricture dilation with SSR. An endoscopic sphincterotomy was performed and a guide wire was inserted beyond the stricture. Then the SSR was introduced over the guide wire via duodenoscope. Then the stricture was traversed by torquing the SSR clockwise while pushing it. The SSR was removed and then the plastic or metal stents were inserted above the stricture. RESULTS: Of the 14 patients, 13 patients (93%) underwent successful stenting using SSR. Symptom relief was observed in all patients after endoscopic biliary stenting. One patient (7%) went on to percutaneous biliary drainage because we failed to insert the metal stent into the stenotic left hepatic duct after traversing the stricture with SSR. There were no significant complications such as bile duct or duodenal perforation and bleeding. CONCLUSIONS: The Soehendra stent retriever is useful and safe for dilation with subsequent stent placement of malignant pancreaticobiliary stirictures resistant to conventional stenting. However, this device may be difficult to pass a tortuous or small-diameter hilar stricture.
Bile Ducts ; Catheters ; Constriction, Pathologic* ; Drainage* ; Duodenoscopes ; Hemorrhage ; Hepatic Duct, Common ; Humans ; Palliative Care ; Plastics ; Sphincterotomy, Endoscopic ; Stents*

PURPOSE: Leptomeningeal carcinomatosis occurs in about 5% of patients with solid tumor and is being diagnosed with increasing frequency as patients live longer and as neuro-imaging studies improve. In general, the most commom cancers that involved the leptomeninges are breast cancer, lung cancer, and malignant melanoma. MATERIALS AND METHODS: We investigated 25 patients presented with multiple neurologic symptoms and signs who were diagnosed with leptomeningeal carcinomatosis at the Yonsei Cancer Center from January 1990 to December 1999. RESULTS: The primary disease of leptomeningeal carcinomatosis were stomach cancer (10 cases), breast cancer (7 cases), lung cancer (5 cases), unknown primary cancer (2 cases) and common bile duct cancer (1 case). All patients were presented with multiple neurologic symptoms and signs involving the central nervous system (CNS), cranial nerve or spinal nerves. Twenty-one of twenty- five patients were treated with intrathecal chemotherapy, radiotherapy, or combination therapy. Fourteen of them (66.7%) experienced improvement or stabilization of neurologic symptom and sign. The median survival was 122 days (10-2190). CONCLUSION: In conclusion, although early diagnosis and active treatment of leptomeningeal carcinomatosis may improve the quality of life in selected patients, the median survival was relatively short. Therefore, new diagnostic and therapeutic strategy for leptomeningeal carcinomatosis were needed.
Breast Neoplasms ; Central Nervous System ; Common Bile Duct ; Cranial Nerves ; Drug Therapy ; Early Diagnosis ; Humans ; Lung Neoplasms ; Melanoma ; Meningeal Carcinomatosis* ; Neurologic Manifestations ; Quality of Life ; Radiotherapy ; Spinal Nerves ; Stomach Neoplasms